Citation Nr: 9901532
Decision Date: 01/21/99 Archive Date: 02/01/99
DOCKET NO. 93-22 065 ) DATE
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On appeal from the
Department of Veterans Affairs Regional Office in St.
Petersburg, Florida
THE ISSUE
Entitlement to service connection for hypertension.
ATTORNEY FOR THE BOARD
T. L. Douglas, Associate Counsel
INTRODUCTION
The veteran served on active duty from March 1985 to
September 1991.
This matter comes before the Board of Veterans’ Appeals
(Board) on appeal from a May 1992 rating decision by the
Atlanta, Georgia, Regional Office (RO) of the Department of
Veterans Affairs (VA). Subsequently, the case was
transferred to the RO in St. Petersburg, Florida.
The Board remanded the issue of entitlement to service
connection for hypertension for additional development in May
1995 and February 1997.
FINDINGS OF FACT
1. All relevant evidence necessary for an equitable
disposition of this appeal has been obtained.
2. Persuasive medical evidence demonstrates that the
veteran’s hypertension is labile and not chronic.
CONCLUSION OF LAW
The veteran does not have chronic hypertension as a result of
an injury or disease incurred in, or aggravated by, active
service. 38 U.S.C.A. §§ 1110, 1112(a)(1), 1131 (West 1991);
38 C.F.R. §§ 3.303, 3.309 (1998).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
Background
Service medical records show the veteran had elevated blood
pressure readings during active service, including 136/90 in
August 1986, in February 1987, 134/92, and in July 1987,
136/94 and 131/94. On examination in March 1990, the blood
pressure reading was 129/103.
VA examination in March 1992 noted blood pressure readings
were: sitting 130/100, recumbent 150/90, and standing
140/100. The diagnoses included systemic hypertension. In
August 1992 VA examination found blood pressure readings of
sitting 140/90, recumbent 140/80, and standing 140/100. It
was noted the veteran was trying to control his blood
pressure through diet. The diagnosis was systemic
hypertension, labile. VA outpatient treatment records dated
in August 1992 noted the veteran’s blood pressure findings
were 138/84 and 144/84.
VA examination in August 1998 included blood pressure
readings 133/89, 131/82, 122/88, and 132/82. It was noted
that the claims file had been reviewed. The diagnosis was
labile arterial hypertension. The examiner noted that the
veteran did not have chronic hypertension, and that labile
hypertension meant that his blood pressure readings were not
constantly elevated.
Analysis
Initially, the Board notes that the veteran’s claim is found
to be well-grounded under 38 U.S.C.A. § 5107(a) (West 1991).
That is, based upon medical findings of labile hypertension,
he has presented a claim which is plausible. Murphy v.
Derwinski, 1 Vet. App. 78 (1990). The Board is also
satisfied that all relevant facts have been properly
developed, and that no further assistance is required in
order to satisfy the duty to assist mandated by 38 U.S.C.A.
§ 5107(a).
Service connection may be granted for a disability resulting
from personal injury suffered or disease contracted in line
of duty or for aggravation of preexisting injury suffered or
disease contracted in line of duty. 38 U.S.C.A. §§ 1110,
1131 (West 1991); 38 C.F.R. § 3.303 (1998). Service
connection can also be granted for chronic diseases,
including hypertension, which becomes manifest to a degree of
10 percent or more within one year of separation from active
service. 38 U.S.C.A. § 1112(a)(1) (West 1991); 38 C.F.R.
§ 3.309(a) (1998).
In addition, service connection may be granted for any
disease diagnosed after discharge, when all of the evidence,
including that pertinent to service, establishes the disease
was incurred in service. 38 C.F.R. § 3.303(d). For the
showing of chronic disease in service, there are required a
combination of manifestations sufficient to identify a
disease entity, and sufficient observation to establish
chronicity at the time, as distinguished from merely isolated
findings or a diagnosis including the word chronic.
Continuity of symptomatology is required only where the
condition noted during service is not, in fact, shown to be
chronic or when the diagnosis of chronicity may be
legitimately questioned. When the fact of chronicity in
service is not adequately supported, then a showing of
continuity after discharge is required to support the claim.
38 C.F.R. § 3.303(b).
The United States Court of Veterans Appeal (Court) has held
that the chronicity provision of 38 C.F.R. § 3.303(b) is
applicable where evidence, regardless of its date, shows that
a veteran had a chronic condition in service or during an
applicable presumptive period and still has such condition.
Such evidence must be medical unless it relates to a
condition as to which, under the Court’s case law, lay
observation is competent. If the chronicity provision is not
applicable, a claim may still be well grounded if the
condition is observed during service or any applicable
presumptive period, continuity of symptomatology is
demonstrated thereafter, and competent evidence relates the
present condition to that symptomatology. Savage v. Gober,
10 Vet. App. 488 (1997).
The Court has held that a witness must be competent in order
for statements or testimony to be probative of the facts
under consideration. See Espiritu v. Derwinski, 2 Vet. App.
492, 494 (1992). The Court has also held that “Congress
specifically limits entitlement for service-connected disease
or injury to cases where such incidents have resulted in a
disability. In the absence of proof of a present disability
there can be no valid claim.” Brammer v. Brown, 3 Vet. App.
223, 225 (1992); see also Rabideau v. Derwinski, 2 Vet. App.
141, 143-44 (1992).
In this case, the Board finds that the medical evidence of
record does not demonstrate the onset of a chronic disability
during or after active service. The service medical records
reflect occasional elevated blood pressure readings, but no
findings of essential hypertension. Blood pressure readings
have been episodically elevated, but not persistently so.
The single diagnosis of systemic hypertension in March 1992
has not been repeated. When requested to provide an opinion
specifically addressing the nature of the veteran’s
hypertension, the VA examiner in August 1998, found the
record was not suggestive of a chronic disorder. This
finding is highly probative since it was made after reviewing
the overall record.
The only evidence of chronic hypertension is the veteran’s
own opinion. While he is competent to testify as to symptoms
he experiences, he is not competent to provide a medical
opinion because this requires specialized medical knowledge.
See Espiritu, 2 Vet. App. at 494.
When all the evidence is assembled, the Secretary, is then
responsible for determining whether the evidence supports the
claim or is in relative equipoise, with the veteran
prevailing in either event, or whether a preponderance of the
evidence is against the claim, in which case the claim is
denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990).
The Board finds the preponderance of the evidence is against
the claim for service connection for hypertension.
ORDER
Entitlement to service connection for hypertension is denied.
THOMAS J. DANNAHER
Member, Board of Veterans' Appeals
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991 & Supp. 1998), a decision of the Board of Veterans'
Appeals granting less than the complete benefit, or benefits,
sought on appeal is appealable to the United States Court of
Veterans Appeals within 120 days from the date of mailing of
notice of the decision, provided that a Notice of
Disagreement concerning an issue which was before the Board
was filed with the agency of original jurisdiction on or
after November 18, 1988. Veterans' Judicial Review Act,
Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The
date which appears on the face of this decision constitutes
the date of mailing and the copy of this decision which you
have received is your notice of the action taken on your
appeal by the Board of Veterans' Appeals.
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